Paraphilic transtorno involving solitary behaviour or consenting individuals is characterised by a persistent and intense padrão of atypical sexual arousal — manifested by sexual thoughts, fantasies, urges, or behaviours — that involves consenting adults or solitary behaviours. One of the following two elements must be present: 1) the person is markedly distressed by the nature of the arousal padrão and the distress is not simply a consequence of rejection or feared rejection of the arousal padrão by others; or 2) the nature of the paraphilic behaviour involves significant risk of injury or death either to the individual or to the partner (e.g., asphyxophilia).